ANESTHESIA

Procedure Codes
eMedNY New York State Medicaid Provider Procedure
Code Manual

Provider Policy Anesthesia

April 2024 1
ANESTHESIA
eMedNY > Procedure Codes

New York State Medicaid

Office of Health Insurance
Department of Health

CONTACTS and LINKS:

eMedNY URL
https://www.emedny.org/

ePACES Reference Guide

https://www.emedny.org/selfhelp/ePACES/PDFS/5010_ePACES_Professional_Real_Time_Claim_Ref
erence_Guide.pdf

eMedNY Contact Information

(800) 343-9000
eMedNY: Billing Questions, Remittance Clarification, Request for Claim Forms, ePACES
Enrollment, Electronic Claim Submission Support (eXchange, FTP), Provider Enrollment, Requests
for paper prior approval forms

eMedNY Contacts PDF

Provider Policy Anesthesia

April 2024 2
ANESTHESIA
eMedNY > Procedure Codes

Table of Contents
1 DOCUMENT CONTROL PROPERTIES 4
2 ANESTHESIA GENERAL INFORMATION AND RULES 4
3 MMIS ANESTHESIA MODIFIERS: 6
4 ANESTHESIA SERVICES 7
4.1 HEAD 7
4.2 NECK 8
4.3 THORAX (CHEST WALL and SHOULDER GIRDLE) 8
4.4 INTRATHORACIC 9
4.5 SPINE and SPINAL CORD 9
4.6 UPPER ABDOMEN 10
4.7 LOWER ABDOMEN 10
4.8 PERINEUM 11
4.9 PELVIS (EXCEPT HIP) 12
4.10 UPPER LEG (EXCEPT KNEE) 12
4.11 KNEE and POPLITEAL AREA 12
4.12 LOWER LEG (BELOW KNEE, INCLUDES ANKLE and FOOT) 13
4.13 SHOULDER and AXILLA 13
4.14 UPPER ARM and ELBOW 14
4.15 FOREARM, WRIST, and HAND 14
4.16 RADIOLOGICAL PROCEDURES 14
4.17 BURN EXCISIONS or DEBRIDEMENT 15
4.18 OBSTETRIC 15
4.19 OTHER PROCEDURES 16

Provider Policy Anesthesia

April 2024 3
ANESTHESIA
eMedNY > Procedure Codes

1 DOCUMENT CONTROL PROPERTIES

Control Item Value

Document Name Anesthesia Procedure Codes
Document Control Number 2024-1
Document Type Procedure Code Manual
Document Version 2024-V1
Document Status
Effective date April 2024

2 ANESTHESIA GENERAL INFORMATION AND RULES

A. Only anesthesiologists may be reimbursed for anesthesia services performed or provided
by themselves or their supervised designees under the codes listed in this section.

B. The total values for anesthesia services include pre- and post- operative visits, the
administration of the anesthetic and the administration of fluids and/or blood incident to
the anesthesia or surgery.

C. Calculated values for anesthesia services are to be used only when the anesthesia is
administered by an anesthesiologist or supervised designee who remains in constant
attendance during the procedure for the sole purpose of rendering such anesthesia
service.

1. Anesthesia time is defined as the period during which an anesthesia practitioner

is present with the patient. It starts when the anesthesia practitioner begins to
prepare the patient for anesthesia services in the operating room or an
equivalent area and ends when the anesthesia practitioner is no longer furnishing
anesthesia services to the patient, that is, when the patient may be placed safely
under postoperative care.
2. Anesthesia time is a continuous time period from the start of anesthesia to the
end of an anesthesia service. In counting anesthesia time for services furnished,
the anesthesia practitioner can add blocks of time around an interruption in
anesthesia time as long as the anesthesia practitioner is furnishing continuous
anesthesia care within the time periods around the interruption.

D. To bill for anesthesia time, report the total time in minutes in the unit’s field. The
maximum conversion factor is $10.00 per each 15 minutes. Do not include Basic Value in
the reported minutes.

Provider Policy Anesthesia

April 2024 4
ANESTHESIA
eMedNY > Procedure Codes

E. Anesthesia Report (or Operative Record) must document total time spent with the
patient and include starting time, completion time and an explanation of any unusual
occurrence which prolonged anesthesia time. If your claim is rejected for anesthesia
exceeding the maximum, you can resubmit a paper claim with documentation
supporting the time billed.

F. When more than one anesthesiologist is billing due to attending in shifts, only the first
anesthesiologist will be reimbursed the Basic Value.

G. When multiple or bilateral surgical procedures, which add time and complexity to patient
care, are performed at the same operative session, the total anesthesia time should be
indicated in minutes using only the anesthesia procedure with the highest base value.
Basic Values are listed in the Fee Schedule.

H. When hypothermia and/or a pump oxygenator are employed in conjunction with an

anesthetic, see procedure code(s) 99116, 99190, 99191, 99192.

I. No fee will be allowed for local infiltration or digital block anesthesia administered by the
operating surgeon.

J. The basic value for anesthesia covers services rendered from the time the
anesthesiologist (or his/her associate) meets the patient in pre-operative holding until
the patient is signed out of the post anesthesia care unit by the attending
anesthesiologist (or his/her associate), this includes the insertion of epidural catheters or
the administration of nerve blocks done in this time frame for post-operative pain
control.

K. Administration of a nerve block (either as a component of the anesthesia itself or a post-

operative pain management protocol) is considered part of the anesthesia time for
surgery. This will not be reimbursed as a separate and distinct procedural service when
performed by the same provider (or his/her associate) that has provided the anesthesia
for the surgical procedure itself. Post op visits are included in the total value for
anesthesia services as per rule #2 above.

L. Anesthesia services not connected with surgery will be found in other sections of the
Physician manual.

Provider Policy Anesthesia

April 2024 5
ANESTHESIA
eMedNY > Procedure Codes

3 MMIS ANESTHESIA MODIFIERS:

Note: NCCI associated modifiers are recognized for NCCI code pairs/related edits. For additional
information please refer to the CMS website:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/

23 Unusual Anesthesia: Occasionally, a procedure, which usually requires either no

anesthesia or local anesthesia, because of unusual circumstances must be done
under general anesthesia. This circumstance may be reported by adding the
modifier 23 to the procedure code of the basic service.

AD Medical Supervision by a Physician: More Than Four Concurrent Anesthesia

Procedures (performed by residents, CRNAs or a combination of both):
Teaching anesthesiologists involved in furnishing more than 4 procedures
concurrently or performing other services while directing concurrent procedures,
will be allowed to bill at the "medical supervision" rate of 3 base units per
procedure. Such cases would be appended with the "AD" modifier (medical
supervision by a physician: more than 4 concurrent anesthesia procedures)

GC This Service has Been Performed in Part by a Resident Under the Direction of a
Teaching Physician:
The modifier is used for those cases in which the teaching anesthesiologist is
involved in single anesthesia case with a resident, two concurrent anesthesia
cases involving residents or a single anesthesia case involving a resident that is
concurrent to another case that does not involve a resident (involves a CRNA).
Reimbursement to the teaching/supervising anesthesiologist for the resident
case(s) will be paid at 100%.

Note: The provision to pay teaching anesthesiologists 100% is strictly limited to

involvement in a maximum of two resident cases only. If the anesthesiologist is
involved in greater than two resident cases concurrently, bill with modifier QK,
(see below).

QK Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures

Involving Qualified Individuals (Residents, 1 or More CRNAs or a Combination of
Both):
The modifier is to be used when the teaching anesthesiologist is medically
directing more than two resident cases concurrently. Reimbursement to the
medically directing anesthesiologist for the resident case(s) will be at 50%.

The modifier is also used for the medical direction of CRNAs, when the CRNAs
are self-employed or employed by the facility. Reimbursement to the medically
directing anesthesiologist for the CRNA case(s) will be at 50%.

Provider Policy Anesthesia

April 2024 6
ANESTHESIA
eMedNY > Procedure Codes

Note: When CRNAs, employed an anesthesiologist or an anesthesiology group,

provide services under the medical direction of an employing anesthesiologist,
the “QK” modifier should not be used. The anesthesia CPT code should be billed
without a modifier under the National Provider Identification (NPI) number of the
anesthesiologist or the anesthesiology group. Reimbursement to the medically
directing anesthesiologist (or to the anesthesia group) for the CRNA case(s) will
be at 100%.

TERMS applicable to the above modifiers:

"Teaching rules" require that the teaching anesthesiologist be present for all critical
or key portions of the case.
"Medical direction" requires that the following seven conditions be met. The
physician must perform the following activities:
• Perform a pre-anesthesia examination and evaluation;
• Prescribe the anesthesia plan;
• Personally participate in the most demanding procedures of the anesthesia
plan, including induction and emergence;
• Ensure that any procedures in the anesthesia plan that he or she does not
perform are performed by a qualified anesthetist;
• Monitor the course of anesthesia administration at frequent intervals;
• Remain physically present and available for immediate diagnosis and treatment
of emergencies; and
• Provide indicated post-anesthesia care.
"Medical supervision" is the term for medical direction of more than four concurrent
anesthesia cases. It may also be used to bill for cases that start out as "medically
directed," but in which the anesthesiologist becomes involved in other activities
and is, therefore, unable to fulfill all seven requirements of medical direction.

4 ANESTHESIA SERVICES

4.1 HEAD
00100 Anesthesia for procedures on salivary glands, including biopsy
00102 Anesthesia for procedures involving plastic repair of cleft lip
00103 Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)
00104 Anesthesia for electroconvulsive therapy
00120 Anesthesia for procedures on external, middle, and inner ear including biopsy; not
otherwise specified
00124 otoscopy
00126 tympanotomy
00140 Anesthesia for procedures on eye; not otherwise specified
00142 lens surgery
00144 corneal transplant
00145 vitreoretinal surgery

Provider Policy Anesthesia

April 2024 7
ANESTHESIA
eMedNY > Procedure Codes

00147 iridectomy
00148 ophthalmoscopy
00160 Anesthesia for procedures on nose and accessory sinuses; not otherwise specified
00162 radical surgery
00164 biopsy, soft tissue
00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 repair of cleft palate
00174 excision of retropharyngeal tumor
00176 radical surgery
00190 Anesthesia for procedures on facial bones or skull; not otherwise specified
00192 radical surgery (including prognathism)
00210 Anesthesia for intracranial procedures; not otherwise specified
00211 craniotomy or craniectomy for evacuation of hematoma
00212 subdural taps
00214 burr holes, including ventriculography
00215 cranioplasty or elevation of depressed skull fracture, extradural
(simple or compound)
00216 vascular procedures
00218 procedures in sitting position
00220 cerebrospinal fluid shunting procedures
00222 electrocoagulation of intracranial nerve

4.2 NECK
00300 Anesthesia for all procedures on the integumentary system, muscles and nerves of
head, neck, and posterior trunk, not otherwise specified
00320 Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic
system of neck; not otherwise specified, age 1 year or older
00322 needle biopsy of thyroid
00326 Anesthesia for all procedures on the larynx and trachea in children younger than 1
year of age
00350 Anesthesia for procedures on major vessels of neck; not otherwise specified
00352 simple ligation

4.3 THORAX (CHEST WALL and SHOULDER GIRDLE)

00400 Anesthesia for procedures on the integumentary system on the extremities, anterior
trunk and perineum; not otherwise specified
00402 reconstructive procedures on breast (eg, reduction or augmentation
mammoplasty, muscle flaps)
00404 radical or modified radical procedures on breast
00406 radical or modified radical procedures on breast with internal mammary node
dissection
00410 electrical conversion of arrhythmias
00450 Anesthesia for procedures on clavicle and scapula; not otherwise specified
00454 biopsy of clavicle
00470 Anesthesia for partial rib resection; not otherwise specified

Provider Policy Anesthesia

April 2024 8
ANESTHESIA
eMedNY > Procedure Codes

00472 thoracoplasty (any type)

00474 radical procedures (eg, pectus excavatum)

4.4 INTRATHORACIC
00500 Anesthesia for all procedures on esophagus
00520 Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise
specified
00522 needle biopsy of pleura
00524 pneumocentesis
00528 mediastinoscopy and diagnostic thoracoscopy not utilizing 1 lung ventilation
00529 mediastinoscopy and diagnostic thoracoscopy utilizing 1 lung ventilation
00530 Anesthesia for permanent transvenous pacemaker insertion
00532 Anesthesia for access to central venous circulation
00534 Anesthesia for transvenous insertion or replacement of pacing cardioverter-
defibrillator
00537 Anesthesia for cardiac electrophysiologic procedures including radiofrequency
ablation
00539 Anesthesia for tracheobronchial reconstruction
00540 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and
mediastinum (including surgical thoracoscopy); not otherwise specified
00541 utilizing 1 lung ventilation
00542 decortication
00546 pulmonary resection with thoracoplasty
00548 intrathoracic procedures on the trachea and bronchi
00550 Anesthesia for sternal debridement
00560 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without
pump oxygenator
00561 with pump oxygenator, younger than 1 year of age
00562 with pump oxygenator, age 1 year or older, for all non-coronary bypass
procedures (eg, valve procedures) or for re-operation for coronary bypass more
than 1 month after original operation
00563 with pump oxygenator with hypothermic circulatory arrest
00566 Anesthesia for direct coronary artery bypass grafting; without pump oxygenator
00567 with pump oxygenator
00580 Anesthesia for heart transplant or heart/lung transplant

4.5 SPINE and SPINAL CORD

00600 Anesthesia for procedures on cervical spine and cord; not otherwise specified
00604 procedures with patient in the sitting position
00620 Anesthesia for procedures on thoracic spine and cord; not otherwise specified
00625 Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic
approach; not utilizing 1 lung ventilation
00626 utilizing 1 lung ventilation
00630 Anesthesia for procedures in lumbar region; not otherwise specified

Provider Policy Anesthesia

April 2024 9
ANESTHESIA
eMedNY > Procedure Codes

00632 lumbar sympathectomy

00635 diagnostic or therapeutic lumbar puncture
00640 Anesthesia for manipulation of the spine or for closed procedures on the cervical,
thoracic or lumbar spine
00670 Anesthesia for extensive spine and spinal cord procedures (eg, spinal instrumentation
or vascular procedures)

4.6 UPPER ABDOMEN

00700 Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified
00702 percutaneous liver biopsy
00730 Anesthesia for procedures on upper posterior abdominal wall
00731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced
proximal to the duodenum; not otherwise specified
00732 endoscopic retrograde cholangiopancreatography (ERCP)
00750 Anesthesia for hernia repairs in upper abdomen; not otherwise specified
00752 lumbar and ventral (incisional) hernias and/or wound dehiscence
00754 omphalocele
00756 transabdominal repair of diaphragmatic hernia
00770 Anesthesia for all procedures on major abdominal blood vessels
00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy;
not otherwise specified
00792 partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)
00794 pancreatectomy, partial or total (eg, Whipple procedure)
00796 liver transplant (recipient)
00797 gastric restrictive procedure for morbid obesity

4.7 LOWER ABDOMEN

00800 Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified
00802 panniculectomy
00811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced
distal to the duodenum; not otherwise specified
00812 screening colonoscopy
00813 Anesthesia for combined upper and lower gastrointestinal endoscopic procedures,
endoscope introduced both proximal and distal to the duodenum
00820 Anesthesia for procedures on lower posterior abdominal wall
00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified
00832 ventral and incisional hernias
00834 Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger
than 1 year of age
00836 Anesthesia for hernia repairs in the lower abdomen not otherwise specified,
00840 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy;
not otherwise specified
00842 amniocentesis
00844 abdominoperineal resection

Provider Policy Anesthesia

April 2024 10
ANESTHESIA
eMedNY > Procedure Codes

00846 radical hysterectomy

00848 pelvic exenteration
00851 tubal ligation/transection
00860 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract;
not otherwise specified
00862 renal procedures, including upper one-third of ureter, or donor nephrectomy
00864 total cystectomy
00865 radical prostatectomy (suprapubic, retropubic)
00866 adrenalectomy
00868 renal transplant (recipient)
00870 cystolithotomy
00872 Anesthesia for lithotripsy, extracorporeal shock wave; with water bath
00873 without water bath
00880 Anesthesia for procedures on major lower abdominal vessels; not otherwise specified
00882 inferior vena cava ligation

4.8 PERINEUM
00902 Anesthesia for; anorectal procedure
00904 radical perineal procedure
00906 vulvectomy
00908 perineal prostatectomy
00910 Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise
specified
00912 transurethral resection of bladder tumor(s)
00914 transurethral resection of prostate
00916 post-transurethral resection bleeding
00918 with fragmentation, manipulation and/or removal of ureteral calculus
00920 Anesthesia for procedures on male genitalia (including open urethral procedures); not
otherwise specified
00921 vasectomy, unilateral or bilateral
00922 seminal vesicles
00924 undescended testis, unilateral or bilateral
00926 radical orchiectomy, inguinal
00928 radical orchiectomy, abdominal
00930 orchiopexy, unilateral or bilateral
00932 complete amputation of penis
00934 radical amputation of penis with bilateral inguinal lymphadenectomy
00936 radical amputation of penis with bilateral inguinal and iliac lymphadenectomy
00938 insertion of penile prosthesis (perineal approach)
00940 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or
endometrium); not otherwise specified
00942 colpotomy, vaginectomy, colporrhaphy, and open urethral procedure
00944 vaginal hysterectomy
00948 cervical cerclage

Provider Policy Anesthesia

April 2024 11
ANESTHESIA
eMedNY > Procedure Codes

00950 culdoscopy
00952 hysteroscopy and/or hysterosalpingography

4.9 PELVIS (EXCEPT HIP)

01112 Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest
01120 Anesthesia for procedures on bony pelvis
01130 Anesthesia for body cast application or revision
01140 Anesthesia for interpelviabdominal (hindquarter) amputation
01150 Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation
01160 Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint
01170 Anesthesia for open procedures involving symphysis pubis or sacroiliac joint
01173 Anesthesia for open repair of fracture disruption of pelvis or column fracture involving
acetabulum

4.10 UPPER LEG (EXCEPT KNEE)

01200 Anesthesia for all closed procedures involving hip joint
01202 Anesthesia for arthroscopic procedures of hip joint
01210 Anesthesia for arthroscopic procedures of hip joint
01212 hip disarticulation
01214 total hip arthroplasty
01215 revision of total hip arthroplasty
01220 Anesthesia for all closed procedures involving upper two-thirds of femur
01230 Anesthesia for open procedures involving upper two-thirds of femur; not otherwise
specified
01232 amputation
01234 radical resection
01250 Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper
leg
01260 Anesthesia for all procedures involving veins of upper leg, including exploration
01270 Anesthesia for procedures involving arteries of upper leg, including bypass graft; not
otherwise specified
01272 femoral artery ligation
01274 femoral artery embolectomy

4.11 KNEE and POPLITEAL AREA

01320 Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee
and/or popliteal area
01340 Anesthesia for all closed procedures on lower one-third of femur
01360 Anesthesia for all open procedures on lower one-third of femur
01380 Anesthesia for all closed procedures on knee joint
01382 Anesthesia for diagnostic arthroscopic procedures of knee joint
01390 Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella
01392 Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella
01400 Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise

Provider Policy Anesthesia

April 2024 12
ANESTHESIA
eMedNY > Procedure Codes

specified
01402 total knee arthroplasty
01404 disarticulation at knee
01420 Anesthesia for all cast applications, removal, or repair involving knee joint
01430 Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified
01432 arteriovenous fistula
01440 Anesthesia for procedures on arteries of knee and popliteal area; not otherwise
specified
01442 popliteal thromboendarterectomy, with or without patch graft
01444 popliteal excision and graft or repair for occlusion or aneurysm

4.12 LOWER LEG (BELOW KNEE, INCLUDES ANKLE and FOOT)

01462 Anesthesia for all closed procedures on lower leg, ankle, and foot
01464 Anesthesia for arthroscopic procedures of ankle and/or foot
01470 Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle,
and foot; not otherwise specified
01472 repair of ruptured Achilles tendon, with or without graft
01474 gastrocnemius recession (eg, Strayer procedure)
01480 Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise
specified
01482 radical resection (including below knee amputation)
01484 osteotomy or osteoplasty of tibia and/or fibula
01486 total ankle replacement
01490 Anesthesia for lower leg cast application, removal, or repair
01500 Anesthesia for procedures on arteries of lower leg, including bypass graft; not
otherwise specified
01502 embolectomy, direct or with catheter
01520 Anesthesia for procedures on veins of lower leg; not otherwise specified
01522 venous thrombectomy, direct or with catheter

4.13 SHOULDER and AXILLA

01610 Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of
shoulder and axilla
01620 Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint,
acromioclavicular joint, and shoulder joint
01622 Anesthesia for diagnostic arthroscopic procedures of shoulder joint
01630 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck,
sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise
specified
01634 shoulder disarticulation
01636 interthoracoscapular (forequarter) amputation
01638 total shoulder replacement
01650 Anesthesia for procedures on arteries of shoulder and axilla; not otherwise specified
01652 axillary-brachial aneurysm

Provider Policy Anesthesia

April 2024 13
ANESTHESIA
eMedNY > Procedure Codes

01654 bypass graft

01656 axillary-femoral bypass graft
01670 Anesthesia for all procedures on veins of shoulder and axilla
01680 Anesthesia for shoulder cast application, removal or repair; not otherwise specified

4.14 UPPER ARM and ELBOW

01710 Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper
arm and elbow; not otherwise specified
01712 tenotomy, elbow to shoulder, open
01714 tenoplasty, elbow to shoulder
01716 tenodesis, rupture of long tendon of biceps
01730 Anesthesia for all closed procedures on humerus and elbow
01732 Anesthesia for diagnostic arthroscopic procedures of elbow joint
01740 Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise
specified
01742 osteotomy of humerus
01744 repair of nonunion or malunion of humerus
01756 radical procedures
01758 excision of cyst or tumor of humerus
01760 total elbow replacement
01770 Anesthesia for procedures on arteries of upper arm and elbow; not otherwise
specified
01772 embolectomy
01780 Anesthesia for procedures on veins of upper arm and elbow; not otherwise specified
01782 phleborrhaphy

4.15 FOREARM, WRIST, and HAND

01810 Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of
forearm, wrist, and hand
01820 Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones
01829 Anesthesia for diagnostic arthroscopic procedures on the wrist
01830 Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius,
distal ulna, wrist, or hand joints; not otherwise specified
01832 total wrist replacement
01840 Anesthesia for procedures on arteries of forearm, wrist, and hand; not otherwise
specified
01842 embolectomy
01844 Anesthesia for vascular shunt, or shunt revision, any type (eg, dialysis)
01850 Anesthesia for procedures on veins of forearm, wrist, and hand; not otherwise
specified
01852 phleborrhaphy
01860 Anesthesia for forearm, wrist, or hand cast application, removal, or repair

4.16 RADIOLOGICAL PROCEDURES

Provider Policy Anesthesia

April 2024 14
ANESTHESIA
eMedNY > Procedure Codes

01916 Anesthesia for diagnostic arteriography/venography

01920 Anesthesia for cardiac catheterization including coronary angiography and
ventriculography (not to include Swan-Ganz catheter)
01922 Anesthesia for non-invasive imaging or radiation therapy
01924 Anesthesia for therapeutic interventional radiological procedures involving the arterial
system; not otherwise specified
01925 carotid or coronary
01926 intracranial, intracardiac, or aortic
01930 Anesthesia for therapeutic interventional radiological procedures involving the
venous/lymphatic system (not to include access to the central circulation); not
otherwise specified
01931 intrahepatic or portal circulation (eg, transvenous intrahepatic portosystemic
shunt[s] [TIPS])
01932 intrathoracic or jugular
01933 intracranial
01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration
procedures on the spine or spinal cord; cervical or thoracic
01938 lumbar sacral
01939 Anesthesia for nerve destruction procedures on spine or spinal cord of neck or upper
back accessed through skin using imaging guidance
01940 lumbar sacral
01941 Anesthesia for nerve modulation procedure spinal cord or repair of bone of spine of
neck or upper back accessed through skin using imaging guidance
01942 lumbar sacral

4.17 BURN EXCISIONS or DEBRIDEMENT

01951 Anesthesia for second- and third-degree burn excision or debridement with or
without skin grafting, any site, for total body surface area (TBSA) treated during
anesthesia and surgery; less than 4% total body surface area
01952 between 4% and 9% of total body surface area
01953 each additional 9% total body surface area or part thereof
(List separately in addition to code for primary procedure)

4.18 OBSTETRIC
01958 Anesthesia for external cephalic version procedure
01960 Anesthesia for vaginal delivery only
01961 Anesthesia for cesarean delivery only
01962 Anesthesia for urgent hysterectomy following delivery
01963 Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care
01965 Anesthesia for incomplete or missed abortion procedures
01966 Anesthesia for induced abortion procedures
01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any
repeat subarachnoid needle placement and drug injection and/or any necessary
replacement of an epidural catheter during labor)

Provider Policy Anesthesia

April 2024 15
ANESTHESIA
eMedNY > Procedure Codes

01968 Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia

(List separately in addition to code for primary procedure performed)
01969 Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia
(List separately in addition to code for primary procedure performed)

4.19 OTHER PROCEDURES

01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or
injection is performed by a different provider); other than the prone position
01992 prone position
01996 Daily hospital management of epidural or subarachnoid continuous drug
administration
01999 Unlisted anesthesia procedure(s)

Provider Policy Anesthesia

April 2024 16